摘要
目的 探讨并比较早产儿与足月儿化脓性脑膜炎（简称“化脑”）临床表现、病原学特点及转归.方法 收集2006-2015年上海交通大学医学院附属新华医院新生儿科收治的化脑患儿,按胎龄分为早产儿组与足月儿组,比较两组患儿出生情况、母孕期情况、临床表现、并发症、病原学结果、治疗及转归.结果 研究期间共纳入早产儿化脑44例,足月儿化脑118例.早产儿与足月儿化脑组发病日龄分别为11.2（3.2,19.8）d、14.3（5.6,23.9）d,差异有统计学意义（P＜0.05）;早产儿化脑组预后明显较足月儿组差（P＜0.05）.足月儿化脑组发热（78.8％比54.5％）、惊厥（26.3％比11.4％）发生率明显高于早产儿组（P＜0.05）,早产儿化脑组嗜睡反应差（59.1％比38.1％）、体重增长缓慢（9.1％比0％）、呼吸暂停（45.5％比0.8％）、口唇发绀（15.9％比4.2％）发生率显著高于足月儿组（P＜0.05）.有并发症与无并发症化脑组发病日龄分别为9.5（4.1,20.5）d、13.8（5.9,22.0）d,疗程分别为（42.2±8.8）d、（28.7±7.1）d,病原学阳性率分别为73.8％、26.7％,组间比较差异均有统计学意义（P＜0.05）.病原中,无论早产儿或足月儿,凝固酶阴性葡萄球菌均占首位,早产儿肺炎克雷伯杆菌阳性率明显高于足月儿组（40.0％比10.4％,P＜0.05）.结论 早产儿化脑临床表现不典型,发病日龄小,预后差,有并发症者疗程延长.新生儿化脑病原菌有变迁,条件致病菌检出率逐年升高,应引起临床医生关注.
Objective To study the differences of clinical manifestations,etiology and hospitalized outcomes of purulent meningitis in preterm and term infants.Method All preterm and term infants with purulent meningitis hospitalized in the Hospital from 2006 to 2015 were enrolled in this study.The data of neonate＇s condition,maternal condition,clinical manifestations,complications,etiology,treatment and outcomes of the preterm and term infants groups were compared.Result During the study period,44 preterm infants and 118 term infants were included.The time of onset for purulent meningitis of preterm infants group was statistically earlier than that of term infants group [11.2 （3.2,19.8） d vs.14.3 （5.6,23.9） d,P 〈 0.05].The prognosis of preterm infants group was statistically worse than that of term infants group （P 〈 0.05）.Among them,the incidences of clinical manifestations in preterm infants group compared to term infants group were：fever （54.5% vs.78.8%）,seizure （11.4% vs.26.3%）,lethargy and poor response （59.1% vs.38.1%）,slow weight gain （9.1% vs.0%）,apnea （45.5% vs.0.8%） and cyanosis （15.9% vs.4.2%）;all the differences between two groups were significant （P 〈 0.05）.The time of onset for purulent meningitis with complications was statistically earlier than those without complications [9.5 （4.1,20.5） d vs.13.8 （5.9,22.0） d,P〈0.05].The duration of treatment for purulent meningitis with complications was longer than that without complications [（42.2 ± 8.8） d vs.（28.7 ± 7.1） d,P 〈 0.05],and the positive rate of pathogens was also statistically higher than those without complications （73.8% vs.26.7%,P 〈0.05）.Coagulase-negative staphylococcus was the main pathogen for both preterm and term infants group.Klebsiella pneumoniae was more common in preterm infants group than in term infants group （40.0% vs.10.4%,P 〈0.05）.Conclusion Preterm infants with purulent meningitis had early onset time,atypical clinical manifestations,and poor prognosis.The
关键词
脑膜炎
细菌性
临床研究
病原
婴儿
早产
Meningitis,bacterial
Clinical research
Noxae
Infant, premature
